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Discuss polyp cancer?

American College of Gastroenterology guidelines recommend that no further treatment is necessary if all the following criteria are fulfilled:

  • The polyp is completely excised by the endoscopist and is submitted in toto for pathological examination.
  • Histology- it is possible to accurately determine the depth of invasion, grade of differentiation, and completeness of excision of the carcinoma.
  • The cancer is not poorly differentiated.
  • There is no vascular or lymphatic involvement.
  • The margin of the excision is not involved. Invasion of the stalk of a pedunculated polyp, by itself, is not an unfavorable prognostic finding, as long as the cancer does not extend to the margin of stalk resection.

When all of these low risk criteria are not met, the decision to proceed to surgical resection needs to be individualized, taking into account the age and comorbidity of the patient. Surgical resection is generally recommended for any invasive cancer in a sessile adenoma where the patient is otherwise well.

Cancerous polyp are often described using Haggitt levels.

Cancerous polyps are classified according to Haggitt level:

Level 0- carcinoma in situ

Level 1- submucosa in the head of the polyp

Level 2- submucosa in the neck of the polyp

Level 3- submucosa in the stalk of the polyp

Level 4- submucosa beyond the stalk

Polyps classified as Haggitt level 3 or lower have a less than 1% likelihood of lymph node metastasis and can be treated with polypectomy alone when they meet the following pathologic criteria:

Specimen margins are greater than 2 mm

There is no evidence of lymphovascular invasion and

The tumour is well differentiated.

Haggitt level 4 polyps have a 12-25% risk of lymph node metastasis and should be treated with segmental colectomy.

Reference:

American College of Gastroenterology Guidelines (Archived copy at WebCite)


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